Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 1999 Current Population Survey

This Issue Brief provides
summary data on the insured and uninsured populations in
the nation and in each state. It discusses the
characteristics most closely related to an individual's
health insurance status. Based on EBRI estimates from the
March 1999 Current Population Survey (CPS), it represents
1998 datathe most recent data available.

In 1998, 194.7 million nonelderly
Americans81.6 percenthad some form of health
insurance. More than 64 percent had it through an
employment-based health plan; 6.5 percent purchased it on
their own; and 14.3 percent were covered by a public
program, mostly through Medicaid (10.4 percent).

In 1998, 18.4 percent of the
nonelderly population was uninsured (43.9 million
people), compared with 14.8 percent in 1987. The
percentage of uninsured Americans has generally been
increasing since at least 1987, although the percentage
uninsured in 1998 was not statistically different from
the percentage uninsured in 1997 (18.3 percent). The
increase in the uninsured prior to 1993 can be attributed
to the erosion of employment-based health insurance.
However, since 1993, the percentage of nonelderly
Americans covered by an employment-based health plan has
increased from 63.5 percent to 64.9 percent.

The decline in public sources of
health insurance would mostly explain the recent increase
in the uninsured. For example, between 1994 and 1998 the
percentage of nonelderly Americans covered by
CHAMPUS/CHAMPVA declined from 3.8 percent to 2.9 percent,
in large part due to downsizing in the military.
Similarly, between 1993 and 1998, the percentage of
nonelderly Americans covered by Medicaid declined from
12.7 percent to 10.4 per-cent as people left welfare.

The increase in employment-based
coverage since 1994 was due mainly to a higher likelihood
that children were covered by an employment-based health
plan. Between 1994 and 1998, the percentage of children
covered by an employment-based health plan increased from
58.1 percent to 60.2 percent. For adults, it increased
less than one percentage point, from 66.1 percent to 66.9
percent.

Adults started to realize gains in
employment-based health insurance between 1997 and 1998.
Between 1994 and 1997, the percentage of working adults
with employment-based health insurance coverage held
steady at roughly 72.3 percent. During this period,
health care cost inflation was essentially nonexistent.
However, between 1997 and 1998, the percentage of working
adults with employment-based health insurance increased
from 72.2 percent to 72.8 percent, despite the apparent
return of health care cost inflation in 1998. It is
likely that the changing composition of the labor force
accounted for some of the increase in employment-based
coverage.